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Int J Sports Med 2021; 42(03): 246-252
DOI: 10.1055/a-1263-1124
Physiology & Biochemistry

Blood Pressure Response to Muscle Metaboreflex Activation is Impaired in Men Living with HIV

Gabriel Gama
1   Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
,
Paulo Farinatti
1   Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
2   Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Niteroi, Brazil
,
Antonio Crisafulli
3   Department of Medical Science and Public Health, University of Cagliari, Italy
,
Juliana Borges
1   Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
› Author Affiliations Funding: This work was partially supported by the Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ, grants E-26/202.720/2019, E-26/010.100935/2018, and E-26/202.880/2017) and the Brazilian Council for the Scientific and Technological Development (CNPq, grant 304798/2016-9).
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Abstract

We investigated the muscle metaboreflex contribution to blood pressure response during dynamic handgrip exercise in men living with HIV (MLHIV) vs. without HIV (Controls). Pressor and heart rate responses were evaluated during metaboreflex activation through post-exercise muscle ischemia (PEMI) method and control exercise session (CER) in 17 MLHIV and 21 Controls. Protocols were performed randomly on the same day, being both sessions composed of 12 min, as follows: a) 3 min at rest, b) 3 min of dynamic handgrip exercise at 30% of maximal voluntary contraction, c) 3 min of recovery post-exercise with vascular occlusion (occlusion only in PEMI), and d) 3 min of recovery post-exercise without vascular occlusion. To assess metaboreflex response, differences between PEMI and CER in recovery post-exercise were calculated for blood pressure and heart rate. Systolic and mean blood pressure (P<0.01) were superior in the last 2 min of recovery with vascular occlusion at PEMI in relation to CER for both groups. No difference was found between groups for blood pressure and heart rate (P>0.05). However, metaboreflex response for systolic blood pressure was lower in MLHIV vs. Controls (4.05±4.63 vs. 7.61±3.99 mmHg; P=0.01). In conclusion, pressor response during metaboreceptor stimulation was attenuated in men living with HIV, which may suggest loss of muscle metaboreflex sensibility.

Key words

exercise - ergoreflex - exercise pressor reflex - HIV infection


Publication History

Received: 20 April 2020

Accepted: 24 August 2020

Article published online:
14 October 2020

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Global Burden of Disease Health Financing Collaborator Network. Spending on health and HIV/AIDS: Domestic health spending and development assistance in 188 countries, 1995–2015. Lancet 2018; 391: 1799-1829 DOI: 10.1016/S0140-6736(18)30698-6.
    CrossrefPubMedGoogle Scholar
  • 2 The Joint United Nations Programme on HIV and AIDS (UNAIDS). Global HIV & AIDS statistics — 2020 fact sheet (August 19, 2020). In Internet: https://www.unaids.org/en/resources/fact-sheet; (August 20, 2020)
  • 3 World Health Organization. Number of deaths due to HIV/AIDS (May 19, 2020). In Internet: https://www.who.int/gho/hiv/epidemic_status/deaths_text/en/; (June 17, 2020)
  • 4 Panel of Experts from the Metabolic Disorders and Comorbilities Study Group (GEAM), Aids Study Group (GeSIDA), National Aids Plan (PNS). Executive summary of the consensus document on metabolic disorders and cardiovascular risk in patients with HIV infection. Enferm Infecc Microbiol Clin 2019; 37: 50-55 DOI: 10.1016/j.eimc.2017.06.007.
    CrossrefPubMedGoogle Scholar
  • 5 Spierer DK, DeMeersman RE, Kleinfeld J. et al. Exercise training improves cardiovascular and autonomic profiles in HIV. Clin Auton Res 2007; 17: 341-348 DOI: 10.1007/s10286-007-0441-0.
    CrossrefPubMedGoogle Scholar
  • 6 Borges J, Soares P, Farinatti P. Autonomic modulation following exercise is impaired in HIV patients. Int J Sports Med 2012; 33: 320-324 doi:10.1055/s-0031-1297954
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Quiles N, Garber C, Ciccolo J. Resting autonomic function in active and insufficiently active people living with HIV. Int J Sports Med 2018; 39: 73-78 doi:10.1055/s-0043-118033
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Sakhuja A, Goyal A, Jaryal AK. et al. Heart rate variability and autonomic function tests in HIV positive individuals in India. Clin Auton Res 2007; 17: 193-196 DOI: 10.1007/s10286-007-0412-5.
    CrossrefPubMedGoogle Scholar
  • 9 Sterns DA, Ettinger SM, Gray KS. et al. Skeletal muscle metaboreceptor exercise responses are attenuated in heart failure. Circulation 1991; 84: 2034-2039 DOI: 10.1161/01.cir.84.5.2034.
    CrossrefPubMedGoogle Scholar
  • 10 Nobrega AC, O’Leary D, Silva BM. et al. Neural regulation of cardiovascular response to exercise: role of central command and peripheral afferents. Biomed Res Int 2014; 2014: 478965 DOI: 10.1155/2014/478965.
    CrossrefPubMedGoogle Scholar
  • 11 Mitchell JH. Neural control of the circulation during exercise: Insights from the 1970–1971 Oxford studies. Exp Physiol 2012; 97: 14-19 doi:10.1113/expphysiol.2011.058156
    CrossrefPubMedGoogle Scholar
  • 12 Williamson JW. The relevance of central command for the neural cardiovascular control of exercise. Exp Physiol 2010; 95: 1043-1048 doi:10.1113/expphysiol.2009.051870
    CrossrefPubMedGoogle Scholar
  • 13 Williamson JW, Fadel PJ, Mitchell JH. New insights into central cardiovascular control during exercise in humans: A central command update. Exp Physiol 2006; 91: 51-58 doi:10.1113/expphysiol.2005.032037
    CrossrefPubMedGoogle Scholar
  • 14 Fadel PJ, Ogoh S, Keller DM. et al. Recent insights into carotid baroreflex function in humans using the variable pressure neck chamber. Exp Physiol 2003; 88: 671-680
    CrossrefPubMedGoogle Scholar
  • 15 Fadel PJ, Raven PB. Human investigations into the arterial and cardiopulmonary baroreflexes during exercise. Exp Physiol 2012; 97: 39-50 doi:10.1113/expphysiol.2011.057554
    CrossrefPubMedGoogle Scholar
  • 16 Ogoh S, Wasmund WL, Keller DM. et al. Role of central command in carotid baroreflex resetting in humans during static exercise. J Physiol 2002; 543: 349-364
    CrossrefPubMedGoogle Scholar
  • 17 Crisafulli A. The impact of cardiovascular diseases on cardiovascular regulation during exercise in humans: Studies on metaboreflex activation elicited by the post-exercise muscle ischemia method. Curr Cardiol Rev 2017; 13: 293-300 doi:10.2174/1573403X13666170804165928
    CrossrefPubMedGoogle Scholar
  • 18 Crisafulli A, Scott AC, Wensel R. et al. Muscle metaboreflex-induced increases in stroke volume. Med Sci Sports Exerc 2003; 35: 221-228 discussion 229. doi:10.1249/01.MSS.0000048639.02548.24
    CrossrefPubMedGoogle Scholar
  • 19 Mitchell JH, Kaufman MP, Iwamoto GA. The exercise pressor reflex: Its cardiovascular effects, afferent mechanisms, and central pathways. Annu Rev Physiol 1983; 45: 229-242 doi:10.1146/annurev.ph.45.030183.001305
    CrossrefPubMedGoogle Scholar
  • 20 Delaney EP, Greaney JL, Edwards DG. et al. Exaggerated sympathetic and pressor responses to handgrip exercise in older hypertensive humans: Role of the muscle metaboreflex. Am J Physiol Heart Circ Physiol 2010; 299: H1318-H1327 DOI: 10.1152/ajpheart.00556.2010.
    CrossrefPubMedGoogle Scholar
  • 21 Crisafulli A, Salis E, Tocco F. et al. Impaired central hemodynamic response and exaggerated vasoconstriction during muscle metaboreflex activation in heart failure patients. Am J Physiol Heart Circ Physiol 2007; 292: H2988-H2996 DOI: 10.1152/ajpheart.00008.2007.
    CrossrefPubMedGoogle Scholar
  • 22 Holwerda SW, Restaino RM, Manrique C. et al. Augmented pressor and sympathetic responses to skeletal muscle metaboreflex activation in type 2 diabetes patients. Am J Physiol Heart Circ Physiol 2016; 310: H300-H309 DOI: 10.1152/ajpheart.00636.2015.
    CrossrefPubMedGoogle Scholar
  • 23 Roberto S, Marongiu E, Pinna M. et al. Altered hemodynamics during muscle metaboreflex in young type 1 diabetes patients. J Appl Physiol (1985) 2012; 113: 1323-1331 DOI: 10.1152/japplphysiol.00280.2012.
    CrossrefPubMedGoogle Scholar
  • 24 Crisafulli A, Milia R, Vitelli S. et al. Hemodynamic responses to metaboreflex activation: insights from spinal cord-injured humans. Eur J Appl Physiol 2009; 106: 525-533 DOI: 10.1007/s00421-009-1045-2.
    CrossrefPubMedGoogle Scholar
  • 25 Marongiu E, Olla S, Magnani S. et al. Metaboreflex activity in multiple sclerosis patients. Eur J Appl Physiol 2015; 115: 2481-2490 DOI: 10.1007/s00421-015-3271-0.
    CrossrefPubMedGoogle Scholar
  • 26 Thoni GJ, Schuster I, Walther G. et al. Silent cardiac dysfunction and exercise intolerance in HIV+men receiving combined antiretroviral therapies. AIDS 2008; 22: 2537-2540 DOI: 10.1097/QAD.0b013e328319806d.
    CrossrefPubMedGoogle Scholar
  • 27 Murphy MN, Mizuno M, Mitchell JH. et al. Cardiovascular regulation by skeletal muscle reflexes in health and disease. Am J Physiol Heart Circ Physiol 2011; 301: H1191-H1204 DOI: 10.1152/ajpheart.00208.2011.
    CrossrefPubMedGoogle Scholar
  • 28 Harriss DJ, MacSween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817 doi:10.1055/a-1015-3123
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 From the Centers for Disease Control and prevention 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. JAMA 1993; 269: 460
    CrossrefPubMedGoogle Scholar
  • 30 Florindo AA, Latorre Mdo R, Santos EC. et al. Validity and reliability of the Baecke questionnaire for the evaluation of habitual physical activity among people living with HIV/AIDS. Cad Saude Publica 2006; 22: 535-541 S0102-311X2006000300008
    CrossrefPubMedGoogle Scholar
  • 31 Crisafulli A, de Farias RR, Farinatti P. et al. Blood flow restriction training reduces blood pressure during exercise without affecting metaboreflex activity. Front Physiol 2018; 9: 1736 DOI: 10.3389/fphys.2018.01736.
    CrossrefPubMedGoogle Scholar
  • 32 Pickering TG, Hall JE, Appel LJ. et al. Recommendations for blood pressure measurement in humans: an AHA scientific statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee. J Clin Hypertens (Greenwich) 2005; 7: 102-109 DOI: 10.1111/j.1524-6175.2005.04377.x.
    CrossrefPubMedGoogle Scholar
  • 33 Crisafulli A, Concu A. Exercise-induced cardiovascular adjustments by muscle receptors stimulation. In: Selkirk TB, Ed. Focus on Exercise and Health Research. New York: Nova Science; 2006: 181-201
    Google Scholar
  • 34 Smith SA, Mitchell JH, Garry MG. The mammalian exercise pressor reflex in health and disease. Exp Physiol 2006; 91: 89-102 doi:10.1113/expphysiol.2005.032367
    CrossrefPubMedGoogle Scholar
  • 35 Crisafulli A, Salis E, Pittau G. et al. Modulation of cardiac contractility by muscle metaboreflex following efforts of different intensities in humans. Am J Physiol Heart Circ Physiol 2006; 291: H3035-H3042 DOI: 10.1152/ajpheart.00221.2006.
    CrossrefPubMedGoogle Scholar
  • 36 Mulliri G, Sainas G, Magnani S. et al. Effects of exercise in normobaric hypoxia on hemodynamics during muscle metaboreflex activation in normoxia. Eur J Appl Physiol 2019; 119: 1137-1148 DOI: 10.1007/s00421-019-04103-y.
    CrossrefPubMedGoogle Scholar
  • 37 Guyton AC. The relationship of cardiac output and arterial pressure control. Circulation 1981; 64: 1079-1088 doi:10.1161/01.cir.64.6.1079
    CrossrefPubMedGoogle Scholar
  • 38 Keller-Ross ML, Johnson BD, Joyner MJ. et al. Influence of the metaboreflex on arterial blood pressure in heart failure patients. Am Heart J 2014; 167: 521-528 DOI: 10.1016/j.ahj.2013.12.021.
    CrossrefPubMedGoogle Scholar
  • 39 Dubey P, Tiwari S, Bajpai M. et al. Effect of metaboreflex on cardiovascular system in subjects of metabolic syndrome. J Clin Diagn Res 2017; 11: CC01-CC04 DOI: 10.7860/JCDR/2017/27583.10178.
    CrossrefPubMedGoogle Scholar
  • 40 Barclay JK. A delivery-independent blood flow effect on skeletal muscle fatigue. J Appl Physiol (1985) 1986; 61: 1084-1090 doi:10.1152/jappl.1986.61.3.1084
    CrossrefPubMedGoogle Scholar
  • 41 Amann M, Calbet JA. Convective oxygen transport and fatigue. J Appl Physiol (1985) 2008; 104: 861-870 doi:10.1152/japplphysiol.01008.2007
    CrossrefPubMedGoogle Scholar
  • 42 Schuster I, Thoni GJ, Ederhy S. et al. Subclinical cardiac abnormalities in human immunodeficiency virus-infected men receiving antiretroviral therapy. Am J Cardiol 2008; 101: 1213-1217 DOI: 10.1016/j.amjcard.2007.11.073.
    CrossrefPubMedGoogle Scholar
  • 43 Roge BT, Calbet JA, Moller K. et al. Skeletal muscle mitochondrial function and exercise capacity in HIV-infected patients with lipodystrophy and elevated p-lactate levels. AIDS 2002; 16: 973-982 DOI: 10.1097/00002030-200205030-00003.
    CrossrefPubMedGoogle Scholar
  • 44 Matthews LT, Giddy J, Ghebremichael M. et al. A risk-factor guided approach to reducing lactic acidosis and hyperlactatemia in patients on antiretroviral therapy. PLoS One 2011; 6: e18736 DOI: 10.1371/journal.pone.0018736.
    CrossrefPubMedGoogle Scholar
  • 45 Fisher JP, White MJ. Muscle afferent contributions to the cardiovascular response to isometric exercise. Exp Physiol 2004; 89: 639-646 doi:10.1113/expphysiol.2004.028639
    CrossrefPubMedGoogle Scholar
  • 46 Correia D, Rodrigues De Resende LA, Molina RJ. et al. Power spectral analysis of heart rate variability in HIV-infected and AIDS patients. Pacing Clin Electrophysiol 2006; 29: 53-58 DOI: 10.1111/j.1540-8159.2006.00297.x.
    CrossrefPubMedGoogle Scholar
  • 47 Smith JR, Koepp KE, Berg JD. et al. Influence of sex, menstrual cycle, and menopause status on the exercise pressor reflex. Med Sci Sports Exerc 2019; 51: 874-881 DOI: 10.1249/MSS.0000000000001877.
    CrossrefPubMedGoogle Scholar
  • 48 Dart AM, Du XJ, Kingwell BA. Gender, sex hormones and autonomic nervous control of the cardiovascular system. Cardiovas Res 2002; 53: 678-687 doi:10.1016/s0008-6363(01)00508-9
    CrossrefPubMedGoogle Scholar